Your Connection to Healthy Living
Volume 6, Issue 2 | Spring 2018
DAMAGE CONTROL Alarming trends in Colorado could result in a spike in liver disease. Page 4.
Dr. Gerond Lake-Bakaar is working to protect patients from alcoholic liver disease and other causes of liver damage.
2 Screenings for every age 3 Benefits of end-of-life care 6 Preventing kidney stones
porterhospital.org :: Spring 2013
1 PHOTO BY ELLEN JASKOL
A decade-by-decade guide for women’s health screenings
L
et’s face it, ladies, routine health screenings don’t always fit our routine. But it’s important not to let time, finances, or fear sabotage the discovery of health problems.
Mandi Beman, MD, a gynecologist and minimally invasive surgeon with CHPG Women’s Health Porter, offers these screening guidelines for healthy women at average risk for disease.
40s
The 40s are full of questions about mammograms. When to start? How often? Forty is not an automatic start age, but it is time to discuss pros and cons with your provider. Also consider screening for blood pressure annually, cholesterol every five years, diabetes every three years, and vision screening every two to four years.
70s 2
VIBRANT :: Porter Adventist Hospital
20s 3
Make time in the jet-setting 20s to begin cholesterol and blood pressure checks every three to five years. Also, schedule a Pap test every three years beginning at 21 and chlamydia screening for sexually active women up to age 25.
50s
Age 50 brings a not-so-nifty rite of passage: colonoscopy. The good news? If there are no signs of colorectal cancer, you can wait a whopping 10 years to repeat. It’s also the only screening test that can actually prevent cancer because nodules that can turn into cancer are removed during the procedure. At 50, annual mammograms are a must. At 55, if you’re a current or former smoker, begin low-dose CT screening for lung cancer if you smoked the equivalent of a pack a day for 30 years (or two packs for 15 years).
Congratulations on your septuagenarian status and on arriving at another decision about mammography. Some guidelines suggest ceasing mammography at 74, but with increasing life spans, it’s a good idea to discuss the decision with your doctor.
ONE-STOP SCREENINGS
s
Thirty-somethings are in the thick of careers and kids. Lucky for you, there’s just one big screening to remember: At 30, begin getting a Pap test with HPV testing. If both results are normal, you don’t need another for five years.
60s
By the 60s, your screening schedule — like your body — experiences a few starts and stops. At age 65, start bone density (DXA) screening to check for osteoporosis and stop Paps if your recent test history is normal.
Maintaining your health is easier than ever with Porter Adventist Hospital’s new Care on CUE Clinic. This women’s clinic offers backto-back medical screenings, including mammograms, fasting labs, GYN exams, and bone density screenings. Make your appointment at Porter Adventist Hospital’s Care on CUE Clinic today by calling 303-316-6677.
A new definition of high blood pressure means that nearly half of all U.S. adults have hypertension. And nearly half of these are women. Birth control pills raise blood pressure risk in some women, as does menopause.
Porter Adventist Hospital is a regional medical center that provides care for complex health issues. We specialize in complex surgery, cardiovascular care, spine care, joint replacement, liver and kidney transplants, and cancer care. We are part of Centura Health, the region’s leading health care network. Vibrant is published quarterly by Porter Adventist Hospital — Portercare Adventist Health System. The purpose of this publication is to support our mission to improve the health of the residents in our community. No information in this publication is meant as a recommendation or to substitute for your physician’s advice. If you would like to comment or unsubscribe to this magazine, please email us at vibrant@centura.org. Vibrant is produced by Clementine Healthcare Marketing.
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Spring
HEALTH BRIEFS
SCREEN TIME
UND ERSTA N DI N G H OSP I C E C A R E HOSPICE AVAILABLE SOONER AND LONGER Think hospice care is available for only your loved one’s final days? Not so, says Ann Mushinsky, MD, medical director for Porter Hospice who’s board-certified in hospice and palliative care medicine. “You won’t run out of hospice benefits. After the first six months, patients are reevaluated and may be eligible for an unlimited number of two-month renewals.” Mushinsky says many eligible patients miss out on timely hospice services. “Some patients feel they are committing to hospice prematurely. They may have difficulty embracing purely comfort-based care,” she Dr. Ann Mushinsky says. “Patients should also know that if they sign on to hospice, they can graduate if they are doing well or if a new treatment becomes available — and then they can come back.” Mushinsky encourages patients and families to learn more by calling 303-561-5100 or by visiting centura.org/hospice.
HOW HOSPICE HELPS
PORTER HOSPICE
Hospice is a field of medicine that addresses natural end-of-life issues. A few major benefits include:
Porter Hospice is the only hospice residence in the Denver area that allows patients to remain in residence under routine care once symptoms have been addressed. This means that a patient does not need to move to another location when his or her symptoms have been controlled. Porter Hospice offers:
• In-home and inpatient specialized medical care • Counseling for patients and family (free for up to 12 months after a loved one’s passing) • Hospice volunteers who offer companionship and light housework
• Overnight guest stays • 17 private rooms • 24-hour staffing • Chef-prepared meals • Massage, music, and pet therapy
DON'T LEAVE MEDICAL WISHES UNKNOWN Advance directives take the guesswork out of your medical wishes if you are unable to decide for yourself. In Colorado, it’s especially important to have advance directives in place.
PHOTO: ©ISTOCKPHOTO.COM/FZANT
Colorado is a “proxy state,” which means that unless you specify someone to make health decisions for you, things can get complicated. If you have not specified this person — called a “health care agent” — in a Medical Durable Power of Attorney document and you are unable to make your own medical decisions, a hospital chaplain, social worker, or physician must convene a panel of the interested parties in your life to select a proxy to act on your behalf. If a proxy is not agreed upon, it goes to the courts. In Colorado, the three advance directives recognized by state law are: • Medical Durable Power of Attorney, a document that names your health care agent • CPR directive, an indicator of your desire not to have CPR should your heart stop beating • Living will, which specifies your wishes regarding artificial life support
To learn more, visit centura.org and search “advance directives.”
porterhospital.org :: Spring 2018
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L VE A
fter more than a year on the job as Porter Adventist Hospital’s medical director of liver transplantation, Gerond Lake-Bakaar, MD, PhD, has made a surprising local discovery. “I have never seen as much alcoholic liver disease as I see here. I am seeing 10 times more than I used to,” he says. In health-conscious Colorado, it’s a shocking assessment. And while LakeBakaar, who hails most recently from Boston, is quick to note that his observation is anecdotal, he also thinks it’s a good reminder to discuss the effect alcohol has on the liver.
MORE at play
A SILENT EPIDEMIC OF LIVER DISEASE caused by alcohol — and other factors — is happening throughout Denver.
Even if you don’t consider yourself to be a heavy drinker, don’t think you’re off the hook. You don’t have to be an alcoholic to inflict damage on your liver — steady drinking, in excess of four to five drinks a day for 10 or more years, can do the trick. And then there are other factors. There are skyrocketing rates of liver disease, especially among baby boomers, also caused by obesity and hepatitis C. Boomers are five times more likely than other adults to have hepatitis C, and many of them live for years with the disease before being diagnosed. Hepatitis C, which is caused by a virus, wasn’t identified until 1989. Before that, blood screening and infection control techniques during medical procedures and transfusions were not in place to eliminate risks. Shared drug needles and sexual transmission also helped spread the disease. The U.S. Preventive Services Task Force recommends that anyone born between 1945 and 1965 get a screening test for hepatitis C, which is treatable.
ALCOHOL’S EFFECT on the liver
As for obesity, Colorado may rank as one of the healthiest states in the nation but, unfortunately, that might not be a high bar to hit. One in five Colorado adults is obese, a rate that has tripled since 1990. Obesity and type 2 diabetes are major risk factors for liver disease. (See “Protect Your Liver From Damage.”) Colorado ranks second nationally in the number of craft breweries — producing more than 1.4 million barrels of craft beer per year. But how
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VIBRANT :: Porter Adventist Hospital
PROTECT YOUR LIVER FROM DAMAGE
YOUR LIVER
The foods we eat and nonalcoholic beverages we drink also can harm the liver. Nonalcoholic fatty liver disease (NAFLD) is a condition in which excess fat builds up in the liver — and it’s on the rise. It’s now the most common chronic liver disorder in the U.S., affecting 20 percent of adults and 10 percent of children. NAFLD is more common in people with type 2 diabetes and those who are obese. Most often, a fatty liver causes no complications. In some cases, however, fatty liver accompanies inflammation and cellular damage, which can trigger cirrhosis or liver cancer.
much beer — or wine or hard alcohol — does a person need to drink to create irreversible liver damage?
The good news? A healthy diet and weight may help prevent NAFLD. Try these tips:
Dr. Gerond “You don’t drink a bottle of whiskey and end up with Lake-Bakaar alcoholic liver disease. You’re going to need to drink at least four drinks a day for 10 years before you get alcoholic liver disease,” Lake-Bakaar says, noting that females are at greater risk than men. “You need to drink a fair amount, every day, solid. You really have to abuse the liver.”
He also notes that disease depends on how much you drink, not what you drink. “Studies show that the general distribution of liver disease in Europe is the same, yet in Germany, beer is prevalent; in France, it’s wine; and in Scotland, it’s hard liquor." How can the liver, which breaks down alcohol, take such a beating for so long? Calling the liver the best-designed organ in the body, Lake-Bakaar says it is both efficient and self-healing. “You only need one-seventh of your liver for it to fully function. And it regenerates, thus it continues to make up for what you’re damaging.”
How the DAMAGE IS DONE
After years of study, some of which is detailed in his book, Alcohol and the Liver, Lake-Bakaar believes that damage begins at the cellular level with the liver’s mitochondria, the energy producers in cells. “Alcohol is cheap fuel that is metabolized through mitochondria. When the cells see alcohol and other food, it goes for the alcohol first because it’s so easy to burn. In turn, that’s where the damage is done.” The actual mechanisms of damage are not well understood, LakeBakaar says. But researchers do agree that damaged liver cells need to be removed because they lead to chronic inflammation. Eventually, this inflammation causes scar tissue that prevents the liver from functioning properly.
Learn more about the Liver Transplant Center at Porter Adventist Hospital by calling 720-809-8199.
porterhospital.org :: Spring 2018
Eat more fruits, vegetables, and whole grains Avoid or limit sugary drinks Replace saturated fats in meat and high-fat dairy and trans fats in processed food like crackers with healthier fats like olive oil or foods such as walnuts and salmon
Nearly half of all liver disease deaths in 2015 in the U.S. involved alcohol. Alcohol use also increases risk of mouth and breast cancer.
Learn More
If you or a loved one has a pattern of substance abuse, it’s time to turn to treatment that can bring long-term recovery. To learn more about Porter Adventist Hospital’s Substance Use Intensive Outpatient Program, go online to porterhospital.org/behavioral-health or call 720-778-2168.
PHOTOS: ©ISTOCKPHOTO.COM/GEORGERUDY, /VLAJKO611
A lot.
A ROCK
AND A HARD PLACE The surprising cause of most kidney stones — plus how to prevent them The kidneys are bean-shaped, fist-sized filtering units that send important minerals back into the bloodstream and waste and extra fluid to the bladder as urine. The most common type of kidney stone (calcium oxalate) forms when there’s too much waste and too little liquid. Often, not drinking enough water is to blame. Dr. Marklyn Jones
The result? The body keeps too much calcium, which crystallizes. “Calcium is not the culprit. Low urine volume is the culprit,” says Marklyn Jones, MD, a urologist at Porter Adventist Hospital.
Too much salt in the diet makes matters worse. How? “Salt pulls calcium along with it into the urine,” Jones says. Downstream from all this activity is the bladder, which is connected to the kidney by a thin tube called the ureter. A stone the size of a tiny pebble can block urine flow. Blocked urine backs up into the kidney, which swells and triggers five-alarm flank pain. Other symptoms may include blood in the urine, nausea and vomiting, and fever and chills.
WHAT TO DO
TREATMENT See your primary care physician or urologist immediately. Treatments include: Passing the stone on your own Ureteroscopy, which uses small instruments to retrieve or obliterate the stone Shock wave lithotripsy, which uses sound waves to blast the stone Percutaneous stone removal (for large or irregularly shaped stones)
WHAT NOT TO DO
STONE-
COLD STATS Research out of South Carolina suggests that teenagers are at growing risk for kidney stones. In fact, from 1997 to 2012 teens had the highest rate of increase of kidney stones among all groups in a 150,000-patient study. What gives? Marklyn Jones, MD, says Western diets heavy in soda, caffeine, and salt are likely driving the increase.
DO NOT cut back on
calcium. Low dietary calcium increases risk of kidney stones. DO NOT try crash diets, especially high-protein weight loss diets, which have been linked to kidney stone formation.
PREVENTION 10-ounce glasses of water daily. Clear urine signals good hydration. Limit sodium to 1,500 milligrams daily. Eat more fruits and vegetables, which may create urine less conducive to stone formation. Lose weight if you are overweight. Obesity changes the acid levels in the urine, which causes stones not to dissolve well.
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VIBRANT :: Porter Adventist Hospital
IF YOU SUFFER
with recurring kidney stones, a urologist can help you find the cause and the right treatment. Visit centura.org and click the “Find a Provider” tab today.
PHOTOS: ©ISTOCKPHOTO.COM/WAITHAYA PALEE, /CHOMBOSAN
Drink fluids. Jones recommends ten
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to TRY
Local physicians offer health tip trifecta
PHOTO: ©ISTOCKPHOTO.COM/MRPLISKIN
The physicians at Centura Health Physician Group Primary Care Southmoor recently got together to identify the top three things they wish every patient would try:
1. GET ROUTINE PHYSICALS.
2. STAY CURRENT ON IMMUNIZATIONS.
3. GET EXERCISE!
The verdict is out on whether healthy adults need annual head-to-toe physicals. But advancing age and any kind of chronic condition, such as diabetes or high blood pressure, do warrant regular checkups.
Under age 26, get the HPV vaccine. As you age, talk to your provider about tetanus/diphtheria boosters, MMR (measles, mumps, rubella), and the hepatitis vaccine. At age 60, it’s time for a Zoster immunization to protect against shingles in patients who have had chicken pox, as well as the pneumococcal vaccine. Plus, put a flu shot on your calendar now for next year.
In addition to helping with weight control, exercise can actually help you live longer. People who are active for an average of one hour a day have a 40 percent lower risk of dying early, compared with those who are active less than 30 minutes a week.
PRACTICE
Makes Perfect Centura Health Physician Group Primary Care Southmoor has been together under a different name for 28 years. In fact, the internal medicine practice features a staff whose “newbie” came on board 15 years ago. “There’s not one of my partners that I would not send my family to,” says Carol Spies, MD, who co-founded the practice in 1989.
PHOTO BY ELLEN JASKOL
The Southmoor practice, located in the Denver Tech Center in Greenwood Village, is excited about the move to Centura and brings six providers with a wealth of experience in preventive care and chronic disease management.
Linda Davis, MD From Honduras to Aboriginal Australia, diverse experiences have prepared Davis for working with patients in sickness. She also loves ballroom dancing.
Carol Spies, MD Spies loves the long-term relational aspects of being in practice since 1989, and she has cared for three generations within some families.
Helen Kechriotis, MD An internal medicine practitioner for 30 years, Kechriotis has never met a school or neighborhood committee she won’t serve on.
Tambra Woods, MD Woods attended Permian High School in Texas, better known as the inspiration for “Friday Night Lights.”
Timothy Poate, MD As the only male in the practice, Poate escapes once a year on a weeklong backpacking trip in the Colorado mountains to get some male bonding.
Deborah Sato, MD A technically skilled and fearless skier, Sato has tackled the toughest mountains in Japan.
CHPG Primary Care Southmoor is located at 5570 DTC Parkway. Call 303-925-4960 to schedule an appointment.
porterhospital.org :: Spring 2018
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CENTURA HEALTH PHYSICIAN GROUP PRIMARY CARE
Portercare Adventist Health System
AURORA
2525 South Downing Street Denver, CO 80210
CHPG Cornerstar Primary Care (Parker and Arapahoe) 303-269-2626 • cornerstarprimarycare.org
Non-Profit Organization U.S. Postage
PAID
Denver, CO Permit No. 3280
CHPG Southlands Primary Care 303-928-7555 • southlandsprimarycare.org
CASTLE ROCK Ridgeline Family Medicine at the Meadows 720-455-3750 • ridgelinefamilymedicine.org Ridgeline Family Medicine — Castle Pines 303-649-3350 • ridgelinefamilymedicine.org
CENTENNIAL CHPG Grace Family Practice (near Arapahoe and Holly) 720-528-3559 • gracefamilypractice.org
DENVER CHPG Primary Care Highlands (near I-25 and Speer) 303-925-4580 • chpghighlands.org CHPG Primary Care Porter 303-649-3200 • porterprimarycare.org
GREENWOOD VILLAGE CHPG at Denver Tech Center (Ulster and Belleview) 303-770-6500 • dtcfamilymedicine.org CHPG Primary Care Southmoor (in the DTC) 303-925-4960
HIGHLANDS RANCH Highlands Ranch Medical Associates 303-649-3140 highlandsranchmedicalassociates.org
LITTLETON Chatfield Family Medicine 303-738-2714 • chatfieldfamilymedicine.org Clement Park Family Medicine 303-932-2121 clementparkfamilymedicine.org South Suburban Internal Medicine (at Littleton Adventist Hospital) 303-347-9897 southsuburbaninternalmedicine.org
PARKER CHPG Internal Medicine Parker (on hospital campus) 303-770-0500 • internalmedicineparker.org
Your closest Centura Emergency Department is at Porter Adventist Hospital — 2525 South Downing Street. Visit porterhospital.org for wait times. R por egiste terh r osp online ital. org/ at eve nts
FREE CLASSES & EVENTS Around the Community RSVP is required. Locations and times vary and are subject to change. Visit porterhospital.org/events or call 303-765-3825 for more information.
MEDICAL WISHES: MAKING YOURS KNOWN
Advance directives take the guesswork out of your medical wishes if you’re unable to make them yourself. Learn more from Porter Hospice staff in this important class. Date: Wed, May 2 Time: 6-7 p.m. L ocation: Porter Adventist Hospital Conference Center
HEAD TO TOE: WHAT YOU NEED TO KNOW
Ladies, as we age, we need different screenings. Find out what you need to know at each age. Date: Tue, May 8 Time: 6-7 p.m. L ocation: Centura Highlands, 2490 West 26th Avenue, Suite A120
FAMILY MOVIE NIGHTS ARE BACK!
Follow our Facebook page for movie dates and times.
7 SIGNS EVERY WOMAN NEEDS TO KNOW
Heart disease remains a top health concern for women. Learn the most important signs to be on the lookout for and most importantly learn what you can do to prevent it. Date: Wed, May 9 Time: 3-4 p.m. L ocation: Porter Adventist Hospital Conference Center
ORAL HEALTH CONNECTION
Oral health is tied to overall health. Learn what you need to know to prevent oral cancer and other healthrelated issues. Date: Wed, May 16 Time: Noon-1 p.m. L ocation: Porter Adventist Hospital Conference Center
BLOCK THOSE RAYS!
Fun in the sun in Colorado is everywhere. Find out how to enjoy yourself and protect yourself. Date: Wed, May 16 Time: 6-7 p.m. L ocation: Porter Adventist Hospital Conference Center
ALCOHOLIC LIVER DISEASE: THE SILENT EPIDEMIC
In Colorado, we “play hard.” Find out more about the impact of alcohol on your liver. Date: Thu, Jun 7 Time: 6-7 p.m. L ocation: Porter Adventist Hospital Conference Center
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CHPG Primary Care Meridian 303-649-3100 • meridianprimarycare.org Timberview Clinic at Parker (on hospital campus) 303-269-4410 • timberviewclinic.org porterhospital.org
Centura Health does not discriminate against any person on the basis of race, color, national origin, disability, age, sex, religion, creed, ancestry, sexual orientation, and marital status in admission, treatment, or participation in its programs, services and activities, or in employment. For further information about this policy, contact Centura Health’s Office of the General Counsel at 1-303-673-8166 (TTY: 711). Copyright © Centura Health, 2018. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-303-765-3826 (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-303-765-3826 (TTY: 711).